Flagellates I Genito-urinary & Intestinal flagellates Dr. Anuluck Junkum PARA 317221
Objective Can describe the morphology, life cycle, pathology, diagnosis and prevention of pathogenic flagellate
Classification of Protozoa Based on locomotive organs : Amoeba : Pseudopodia Ciliate : Cilia Sporozoa : Flagellate : Body flexion or Gliding Flagella
flagella
Flagellates *
Medical important flagellates 1. In GI tract : Giardia lamblia Non-pathogen Dientamoeba fragilis Trichomonas hominis Trichomonas tenax Chilomastix mesnili 2. In GU tract : Trichomonas vaginalis 3. In blood & tissue : Leishmania spp. & Trypanosoma spp.
Giardia lamblia Name : Giardia lamblia, Giardia intestinalis Disease: Giardiasis Distribution: - Cosmopolitan (most commonly in warm climate) - most common flagellate of human digestive tract
Morphology Trophozoite Sucking disc nucleus median bodies axoneme flagellum Size : 5-15 x 9-21 um Pear-shaped (tear drop) dorsal surface : convex ventral surface : concave 2 ventral sucking disc 2 nucleic central karyosome In middle : axoneme & median bodies 4 pairs of flagella
Giardia lamblia (Trophozoite) Sucking disc Cross section of small intestine Microvilli
Morphology Mature cyst oval shape with 4 nuclei 4 nuclei median bodies axoneme Size : 8-14 x 7-10 um no flagella and sucking disc presence : median bodies, axoneme smooth, colorless cyst wall after excystation: transforms into 2 binucleated trophozoites
Axoneme
Giardia lamblia (cyst) Fragments of sucking disc Axoneme Nucleus Cyst wall
2-15% infection rates in various parts of the world Group infection (children > adult) Fecal-oral transmission (with mature cyst) - contaminated food & water Hiker s diarrhea or Picnicker s disease - direct contaction - sexual transmission (also Homosexual) RH : cats and dogs
- Most cases : asymptomatic - Symptomatic cases * hypercellularity of the lamina propria (mucosa) irritation of epithelial cell increase mucus production * malabsorbtion, steatorrhea without blood * typical symptoms: - steatorrhea without blood - abdominal cramp, diarrhea, - dehydration, weight loss * obstruction of gall bladder jaundice
Stool examinations - falling leaf motility of trophozoites (difficult to see in mucus stool) - non-motile cyst Duodenal drainage or in combination with EnteroTest capsule Immunodiagnosis: ELISA, IFA
EnteroTest capsule
Metronidazole (200-400 mg., 3 times a day) Ornidazole ( 2 g. single dose)
Education of : - personal hygiene - improved sanitary : water treatment (boil or filtrate) control of insects properly treatment of symptomatic and asymptomatic patients
Dientamoeba fragilis
Dientamoeba fragilis Habitat : large intestine (cecum) Distribution : cosmopolitan Locomotive organ : pseudopodia grouped to Flagellate : based on ultrastructure immunological & genetic evidence
Morphology Size 5-12 um - Trophozoite stage only - amoeba-like - Nucleus : no peripheral chromatin 2 nucleus, big karyosome - food vacuole in cytoplasm
Life cycle
o Transmission between human : unclear o not invade tissue o Irritate intestinal mucosa - increase mucus & intestinal movement - abdominal pain, diarrhea (mucous) - nausea, vomiting, low fever - anal pruritus
Stool examination - fresh smear (mucus area) may be confused with E. histolytica - permanent smear
iodoquinol 650mg., 3 times a day, 20 D. tetracycline 500mg., 4 times a day, 10 D. paramomycin 500mg., 3 times a day, 7 D.
Trichomonad
Trichomonad undulating membrane nucleus flagellum karyosome axostyle pyriform shape longitudinal binary fission
T. tenax (mouth) T. hominis (large intestine) T. vaginalis (urogenetal tract)
Morphology T. tenax T. vaginalis T. hominis Length (µm) 5-12 7-23 5-14 No. ant. Flag. 4 4 5 Undulating mem. 3/4 of body 1/2 of body posterior Post. free flag. - - 1
Trichomonas tenax Size : 5x12 µm non-pathogenic flagellate habitat : mouth (tartar from teeth) Transmission : unclear may be cough, sneeze, kissing, co-use utensil undulating membrane : 3/4 of body length feed on bacteria, epithelial cell
Trichomonas hominis Size : 5-15x7-10 µm non-pathogenic flagellate habitat : large intestine most common found next to G. lamblia & D. fragilis Transmission : unclear undulating membrane : cover entire body & projects like a free flagellum movement : jerky, non-direction
Trichomonas vaginalis*** Disease: Habitat : Trichomoniasis Female: vagina, urethra Male: urethra, prostate gland Distribution : Transmission: cosmopolitan sexual transmission
Morphology - Only trophozoite stage* size 7-15x4-7 um - tear drop-shaped - 4 anterior flagella - 1 nucleus at anterior part - undulating membrane = ½ of body length - jerky movement
Epidemiology high prevalence : 16-35 years old (Female) feed on : bacteria & wbc (phagocytosis)
Symptoms Asymptomatic: 20-50% (male usually asymptomatic) Symptomatic * : Female Male - vaginal discharge (foul smell, creamy) - leukorrhea, dysuria - vaginitis, cystitis, vaginal & vulva pruritis - mild symptom - itching, cystitis, prostatitis
T. vaginalis parasite adhering to vaginal epithelial cells
Vaginitis due to T. vaginalis foamy vaginal discharge
Strawberry cervix of trichomoniasis
Diagnosis Microscopic examination * - wet preparation & vaginal swab (vaginal, urethral discharge, prostatic secretion) -jerky movement, tear drop-shaped trophozoite Culture in culture medium (Diamond s medium) Immunodiagnosis : ELISA, IFA
Treatment & prevention Metronidazole : 250 mg, 10 days treat both male & female (couple) hygiene education - use of condom - public toilet - co-use utensil e.g. towel
Lab talk
Giardia lamblia Trophozoite Cyst
Dientamoeba fragilis
Trichomonad T. hominis T. tenax T. vaginalis